The paper analyzed the economies of scale of medical service and its characteristics according to the concepts and original of such a theory. It holds that hospital operations demands an appropriate size; for medical services in need of procuring large equipments, specialized service units of an appropriate size are more cost effective than service provision in individual hospitals; web release of medical service information and price information can help expand the market size; hospital alliances can integrate medical services horizontally and vertically. The above measures can attain the economies of scale for medical service.

Objective To investigate the prevalence of dyspepsia and the relationship between dyspepsia,psychological and social factors among the college students in Naning city,and to improve the prevention and treatment of dyspepsia in this region.Methods Rome Ⅲ diagnostic questionnaire for adult dyspepsia,Chinese college student mental health scale (CCSMHS),Chinese college student psychological stress scale (CCSPSS),Chinese college student adaptation scale (CCSAS) and Chinese college student personality scale (CCSPS) were performed through interview survey in 2 580 Nanning college students.Chi square test and rank sum test were used to compared differences between groups.Correlation analysis was performed by Pearson correlation and Logisitic regression analysis.Results A total of 2 520 qualified Rome m questionnaires were recovered.The prevalence of dyspepsia in Nanning college students was 5.36％(135/2 520).The most common appearance of dyspepsia in college students were dislike of drinking tea (86.96％(100/115) vs 79.10％(1 605/2 029)),dislike of pickled food (85.22％(98/115) vs 76.29％(1 548/2 029)) and missing meals (40.87％(47/115) vs 30.31％(615/2 029)),the differences were statistically significant (x2 =4.122,4.860,5.685;all P＜0.05),while the dyspepsia was not related with drinking,smoking and taking raw,cold or spicy food (all P＞0.05).The results of multifactor regression analysis showed that the prevalence of dyspepsia was not correlated with diet.Among the twelve dimensions of psychological health,the somatization,anxiety,depression,low self-esteem,social withdrawal,sexual psychology,paranoia,force,dependency,psychotic tendencies of dyspepsia group were significantly higher than those with non-dyspepsia group (x2 =16.981,21.805,12.520,13.539,6.998,6.154,15.013,9.457,10.715,4.260,all P＜0.05).Among the seven dimensions of psychological stress,study pressure and development pressure were negative life events,and their of dyspepsia group were significantly higher than those with non-dyspepsia group (x2 =6.216,Fisher exact probability test,both P＜0.05).There was no statistically significant difference between two groups in the seven personality,such as active,outgoing,tenacity,rigorous,altruism,affectionate and easy-going (all P＞0.05).Among the seven dimensions of adaptation,the adaptation to campus life,emotion and career choice of dyspepsia group were significantly lower than those with non-dyspepsia group (x2 =8.223,8.148,5.713,all P＜0.05).While there was no statistically significant difference between two groups in the other four dimensions of adaption,such as relationships,learning,ego and satisfaction (all P＞0.05).The results of Logistic regression analysis in psychological health,stress and adaption of dyspepsia group and non-dyspepsia group indicated that dyspepsia was associated with somatization (odds ration (OR) =1.610,95％ confidence interval (CI) 1.012-2.559),anxiety (OR=1.955,95％CI 1.216-3.142) and the study pressure (OR=2.159,95％CI 1.106-4.213).The results of Pearson correlation analysis in study pressure,somatization and anxiety of dyspepsia group showed that both somatization and anxiety were correlated with study stress in dyspepsia group (r=0.314,0.323;both P＜0.05).Conclusions Dyspepsia is a common symptom in Nanning college students.Students with dyspepsia have different degrees of psychological problems which are mostly anxiety and somatization.And study stress as a negative event is the major stress factor.

Objective To measure the expression of La-related protein 1 (LARP1) in gastric carcinoma and investigate its relationship with the biologic behavior of gastric carcinoma.Methods Expression of LARP1 protein in 30 gastric carcinoma tissues and para-carcinoma tissues and 30 normal gastric specimens was detected by immunohistochemistry.Results The mean density of LARP1 expression in gastric carcinoma (0.19-± 0.13) was significantly higher than that in adjacent tissues (0.07 ± 0.12) and normal tissue (0.01 ± 0.03) (P ＜ 0.01).Along with the increasing of TNM stage,LARP1 in gastric carcinoma tissue expression was significantly increased (stage Ⅰ vs.Ⅱ vs.Ⅲ + Ⅳ =0.06 ± 0.07 vs.0.20 ± 0.12 vs.0.30 ± 0.08,P =0.001) and lymph node metastasis in patients with LARP1 expression levels than those without lymph node metastasis (0.22 ± 0.12 vs.0.11 ± 0.14,P =0.038).The amount of expression in poorly differentiated carcinoma LARP1 is significantly higher than that in high grade carcinoma (0.24 ± 0.12 vs.0.12 ± 0.12,P =0.022),but has no correlation with age or gender of patient.It has no correlation with the size and location of tumor.Conclusions LARP1 is overexpres sed in gastric carcinoma and para-carcinoma tissues.It is significantly related to the malignant biological behavior of gastric cancer and may play an important role in the carcinogenesis and development of gastric carcinoma.

Objective:To evaluate the clinical prognosis of patients with pseudomyxoma peritonei (PMP) after cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC).Methods:The clinical data of 42 patients with PMP after CRS combined with HIPEC in the Affiliated Haikou Hospital of Xiangya Medical College of Central South University from January 2012 to December 2018 was retrospectively analyzed. All patients underwent open surgery CRS combined with HIPEC, the operation condition and prognosis of patients were analyzed.Results:In 42 patients with PMP, the disenminated peritoneal adenomucinosis (DPAM) accounted for 61.9% (26/42), the peritoneal mucinous carcinomatosis (PMCA) accounted for 28.6% (12/42), and the borderline accounted for 9.5% (4/42). The incidence rate of major operative complications (grade Ⅲ-Ⅳ) after CRS combined with HIPEC was 21.4% (9/42). The logistic regression analysis showed that the previous surgery score ( OR = 35.765, 95% CI 2.746-43.986, P = 0.001) and completeness of CRS score ( OR = 23.865, 95% CI 1.345-347.876, P = 0.028) were independent factors influencing major postoperative complications in PMP patients. The overall survival time of 42 patients with PMP was (64.8±4.1) months, and the disease-free survival time was (54.0±4.9) months; the 3-year and 5-year overall survival rates were 80.8% and 65.9%, and the 3-year and 5-year disease-free survival rates were 59.5% and 54.6%, respectively. The difference in overall survival time of patients with different pathological subtypes was statistically significant ( P = 0.022). Conclusion:CRS combined with HIPEC is safe and effective for treatment of patients with PMP, and most of the patients have a good prognosis.

【Objective】 To investigate the clinical application of heparinase-modified TEG (hmTEG) in evaluating coagulation status and monitoring anticoagulant therapy in severe non-ICU patients with COVID-19. 【Methods】 The clinical data of severe non-ICU patients with COVID-19 confirmed to be infected with novel coronary disease (SARS-CoV-2) from December 2022 to May 2023 were analyzed retrospectively. The patients were divided into therapeutic dose group and prophylactic dose group according to the initial dose of enoxaparin. The changes of platelet count, activated partial thromboplastin time, prothrombin time, thrombin time, fibrinogen, D-dimer, TEG and hmTEG before and after heparin treatment were compared between the two groups, so as to evaluate the changes of coagulation function and bleeding risk of COVID-19 severe non-ICU patients after anticoagulation with different doses of heparin. 【Results】 A total of 179 severe non-ICU patients with COVID-19 were enrolled in this study, including 102 patients in therapeutic dose group and 77 patients in prophylactic dose group. Before receiving heparin anticoagulation, except for age(63.4±11.6 vs 59.8±9.1) D-dimer(678 ng/mL vs 621 ng/mL) and MA values [(69.1±10.2)mm vs (65.6±8.5)mm], there were no statistical differences in platelet count, activated partial thromboplastin time, prothrombin time, thrombin time, fibrinogen, R value, K time, α angle and coagulation index (CI) between the therapeutic dose group and the prophylactic dose group (P>0.05). After receiving heparin anticoagulation, there were significant differences in CKR value [(12.2±4.1)min vs (10.2±3.3)min] and CKHR value [(8.1±3.2)min vs (7.1±2.6)min] between therapeutic dose group and prophylactic dose group (P<0.05), but no significant differences in other parameters between groups (P>0.05). Meanwhile, the proportion of heparin overdose in the therapeutic dose group was significantly higher than that in the prophylactic dose group 15.69%(16/102) vs 5.19%(4/77)(P<0.05). However, there was no difference in the incidence of VTE events 2.35 %(2/85) vs 2.78%(2/72), gastrointestinal bleeding 2.35%(2/85) vs 1.39%(1/72), ICU admission 4.71%(4/85) vs 4.17%(3/72) and death events 3.53%(3/85) vs 2.78%(2/72) between the two groups (P>0.05). 【Conclusion】 In the current epidemic trend of COVID-19, in order to reduce the occurrence of bleeding events, the heparin dose should be selected more carefully in the prevention of thrombosis in severe non-ICU patients with COVID-19. The individualized assessment of bleeding risk by hmTEG is more conducive to the adjustment and control of heparin dose.